Paralysis by Analysis

U.S. Hit by Epidemic of Medical Diagnoses

In a recent New York Times essay, “What’s Making Us Sick is an Epidemic of Diagnoses,” Dr. H. Gilbert Welch candidly concludes that “for most Americans, the biggest health threat…is our health-care system.” Not just because of medical error. The larger problem is an epidemic of diagnoses. “Americans live longer than ever,” he observes, “yet more of us are told we are sick.”

One driver is medicalization of everyday life, in which sensations previously considered part of life now are considered symptoms of disease. Even children are subject to lifetime labels at any sign of mild, intermittent or transient symptoms. “Exactly what are we doing to our children when 40 percent of summer campers are on one or more chronic prescription medications?” he queries.

Another driver is the quest to find disease early. New technologies allow doctors to “look really hard for things to be wrong,” so that “it’s possible to give a diagnosis to just about everybody.” Changing rules constantly expand what constitutes disease as acceptable baseline thresholds drop.

Overdiagnosis carries penalties. For those labeled “at risk” or with predisease, but destined to remain healthy, treatment can only cause harm. Potential harms from new therapies can take years to emerge. “Doctors need to remember the value of reassuring people that they are not sick,” avers Welch. It’s past time the National Institutes of Health redirected researchers bent on discovering a new disease to the goal of reducing—not increasing—the need for medical services.